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<iframe id="redirect" style="display:none;" onload="if(submitted) {window.location='http://www.siliconsolar.com';}"></iframe>
<form action="https://docs.google.com/forms/d/1MbAtoJFYa3uKmGLBNKMtc1i-fTnD_L_SizcAMtJYxxU/formResponse" method="POST" target="redirect" onsubmit="alert('Thank You For Your Application.');">
	<h3>SECTION 1: COMPANY INFORMATION</h3>
	<table width="100%" cellpadding="0" cellspacing="0">
	<tr>
      <td colspan="2">
        Company Status:<br>
        <input type="radio" name="entry.1724507134" id="group_1724507134_1" value="Existing">Existing
        <input type="radio" name="entry.1724507134" id="group_1724507134_2" value="Startup">Startup <em>(if startup, please ignore section 3)</em>
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    </tr>
    <tr>
    	<td>
        	Company Name:<br>
            <input type="text" name="entry.284025764" id="entry_284025764" />
        </td>
        <td>
        	# Of Employees:<br>
            <input type="text" name="entry.1245080392" id="entry_1245080392" />
        </td>
    </tr>
    <tr>
    	<td colspan="2">
        	Company Address:<br>
            <input type="text" name="entry.2133539301" id="entry_2133539301" />
        </td>
    </tr>
    <tr>
    	<td>
        	City / State:<br>
            <input type="text" name="entry.144596422" id="entry_144596422" />
        </td>
        <td>
        	Zip Code:<br>
            <input type="text" name="entry.579347923" id="entry_579347923" />
        </td>
    </tr>
    <tr>
    	<td>
        	Federal Tax ID:<br>
            <input type="text" name="entry.1008184281" id="entry_1008184281" />
        </td>
        <td>
        	State Tax ID:<br>
            <input type="text" name="entry.68310225" id="entry_68310225" />
        </td>
    </tr>
    <tr>
    	<td>
        	Date Established:<br>
            <input type="text" name="entry.193312708" id="entry_193312708" />
        </td>
        <td>
        	Type of Organization:<br>
            <input type="text" name="entry.1776386994" id="entry_1776386994" />
        </td>
    </tr>
    <tr>
    	<td colspan="2">
        	County &amp; State of Incorporation or Registration:<br>
            <input type="text" name="entry.682502972" id="entry_682502972" />
        </td>
    </tr>
    <tr>
    	<td colspan="2">
        	Main Activities of the Company:<br>
            <textarea name="entry.144892228" id="entry_144892228" ></textarea>
        </td>
    </tr>
	</table>
    
    <h3>SECTION 2: COMPANY OWNERSHIP</h3>
    <table width="100%" cellpadding="0" cellspacing="0">
    	<tr>
        	<td colspan="3">Please list owners with more than 10% ownership:</td>
        </tr>
        <tr>
        	<td>Name</td>
            <td>Title</td>
            <td>% Share</td>
        </tr>
        <tr>
        	<td><input type="text" name="entry.690079364" id="entry_690079364" /></td>
            <td><input type="text" name="entry.2128303687" id="entry_2128303687" /></td>
            <td><input type="text" name="entry.768856258" id="entry_768856258" /></td>
        </tr>
        <tr>
        	<td><input type="text" name="entry.1013462386" id="entry_1013462386" /></td>
            <td><input type="text" name="entry.14224535" id="entry_14224535" /></td>
            <td><input type="text" name="entry.517893279" id="entry_517893279" /></td>
        </tr>
        <tr>
        	<td><input type="text" name="entry.297390615" id="entry_297390615" /></td>
            <td><input type="text" name="entry.484270850" id="entry_484270850" /></td>
            <td><input type="text" name="entry.1132923850" id="entry_1132923850" /></td>
        </tr>
        <tr>
        	<td><input type="text" name="entry.1501700369" id="entry_1501700369" /></td>
            <td><input type="text" name="entry.26999781" id="entry_26999781" /></td>
            <td><input type="text" name="entry.845720966" id="entry_845720966" /></td>
        </tr>
        <tr>
        	<td><input type="text" name="entry.1972922714" id="entry_1972922714" /></td>
            <td><input type="text" name="entry.1205841755" id="entry_1205841755" /></td>
            <td><input type="text" name="entry_652756579" id="entry_652756579" /></td>
        </tr>
        <tr>
        	<td><input type="text" name="entry.1094990280" id="entry_1094990280" /></td>
            <td><input type="text" name="entry.814496079" id="entry_814496079" /></td>
            <td><input type="text" name="entry.1453875600" id="entry_1453875600" /></td>
        </tr>
    </table>
    
    <h3>SECTION 3: TRADE REFERENCES</h3>
    <table width="100%" cellpadding="0" cellspacing="0">
    	<tr>
        	<td colspan="4">Please list three (3) companies with which you regularly do business:</td>
        </tr>
        <tr>
        	<td colspan="4">
            	First Company Name:<br>
            	<input type="text" name="entry.1689500632" id="entry_1689500632" />
            </td>
        </tr>
        <tr>
        	<td colspan="4">
            	Company Address:<br>
            	<input type="text" name="entry.1575385331" id="entry_1575385331" />
            </td>
        </tr>
        <tr>
        	<td>
            	City:<br>
            	<input type="text" name="entry.1743528683" id="entry_1743528683" />
            </td>
            <td>
            	State:<br>
            	<input type="text" name="entry.1534485827" id="entry_1534485827" />
            </td>
            <td>
            	Zip:<br>
            	<input type="text" name="entry.2031077672" id="entry_2031077672" />
            </td>
            <td>
            	Phone:<br>
            	<input type="text" name="entry.1703929467" id="entry_1703929467" />
            </td>
        </tr>
        <tr>
        	<td colspan="4">
            	Second Company Name:<br>
            	<input type="text" name="entry.1320745101" id="entry_1320745101" />
            </td>
        </tr>
        <tr>
        	<td colspan="4">
            	Company Address:<br>
            	<input type="text" name="entry.209301171" id="entry_209301171" />
            </td>
        </tr>
        <tr>
        	<td>
            	City:<br>
            	<input type="text" name="entry.413406867" id="entry_413406867" />
            </td>
            <td>
            	State:<br>
            	<input type="text" name="entry.1132370739" id="entry_1132370739" />
            </td>
            <td>
            	Zip:<br>
            	<input type="text" name="entry.1491740748" id="entry_1491740748" />
            </td>
            <td>
            	Phone:<br>
            	<input type="text" name="entry.389715258" id="entry_389715258" />
            </td>
        </tr>
        <tr>
        	<td colspan="4">
            	Third Company Name:<br>
            	<input type="text" name="entry.706983770" id="entry_706983770" />
            </td>
        </tr>
        <tr>
        	<td colspan="4">
            	Company Address:<br>
            	<input type="text" name="entry.1616141955" id="entry_1616141955" />
            </td>
        </tr>
        <tr>
        	<td>
            	City:<br>
            	<input type="text" name="entry.1076512333" id="entry_1076512333" />
            </td>
            <td>
            	State:<br>
            	<input type="text" name="entry.893555471" id="entry_893555471" />
            </td>
            <td>
            	Zip:<br>
            	<input type="text" name="entry.886554025" id="entry_886554025" />
            </td>
            <td>
            	Phone:<br>
            	<input type="text" name="entry.365308251" id="entry_365308251" />
            </td>
        </tr>
    </table>
    
    <h3>SECTION 4: CONTACT INFORMATION</h3>
    <table width="100%" cellpadding="0" cellspacing="0">
    	<tr>
        	<td colspan="2">
            	Contact Name:<br>
            	<input type="text" name="entry.1027203244" id="entry_1027203244" />
            </td>
            <td>
            	Title:<br>
            	<input type="text" name="entry.914840389" id="entry_914840389" />
            </td>
        </tr>
        <tr>
        	<td colspan="3">
            	Address:<br>
            	<input type="text" name="entry.942845300" id="entry_942845300" />
            </td>
        </tr>
        <tr>
        	<td>
            	City:<br>
            	<input type="text" name="entry.1552178592" id="entry_1552178592" />
            </td>
            <td>
            	State:<br>
            	<input type="text" name="entry.1563925490" id="entry_1563925490" />
            </td>
            <td>
            	Zip:<br>
            	<input type="text" name="entry.1431505171" id="entry_1431505171" />
            </td>
        </tr>
        <tr>
        	<td colspan="3">
            	Country:<br>
            	<input type="text" name="entry.266488828" id="entry_266488828" />
            </td>
        </tr>
        <tr>
        	<td>
            	Phone:<br>
            	<input type="text" name="entry.125709489" id="entry_125709489" />
            </td>
            <td>
            	Cell:<br>
            	<input type="text" name="entry.1361122191" id="entry_1361122191" />
            </td>
            <td>
            	Fax:<br>
            	<input type="text" name="entry.845529316" id="entry_845529316" />
            </td>
        </tr>
        <tr>
        	<td colspan="3">
            	Email:<br>
            	<input type="text" name="entry.578059429" id="entry_578059429" />
            </td>
        </tr>
        <tr>
        	<td colspan="3">
            	Website:<br>
            	<input type="text" name="entry.538502234" id="entry_538502234" />
            </td>
        </tr>
    </table>
    
    <h3>SECTION 5: EXPERIENCE</h3>
    <table width="100%" cellpadding="0" cellspacing="0">
    	<tr>
        	<td>
            	Please outline why you want to become a Silicon Solar Dealer:<br>
            	<textarea name="entry.1205342464" id="entry_1205342464" ></textarea>
            </td>
        </tr>
        <tr>
        	<td>
            	How can you contribute to Silicon Solar beyond simply sales (contracts, knowledge, industry-standing, introduction of products into niche markets)?<br>
            	<textarea name="entry.1297679119" id="entry_1297679119" ></textarea>
            </td>
        </tr>
        <tr>
        	<td>
            	What other solar companies are selling your market area?<br>
            	<textarea name="entry.1297679119" id="entry_1297679119" ></textarea>
            </td>
        </tr>
        <tr>
        	<td>
            	Do you have an established network through which you currently sell products? If so, please describe and provide examples, if possible:<br>
            	<textarea name="entry.1870157171" id="entry_1870157171" ></textarea>
            </td>
        </tr>
        <tr>
        	<td>
            	What volume of product by sales and/or pieces do you forecast selling with your existing resources?<br>
            	<textarea name="entry.523075241" id="entry_523075241" ></textarea>
            </td>
        </tr>
        <tr>
        	<td>
            	Will you require a sample purchase for product demonstration and testing?<br>
            	<textarea name="entry.1510680847" id="entry_1510680847" ></textarea>
            </td>
        </tr>
        <tr>
        	<td>
            	Please provide any additional information that may be useful for us to determine your capacity to become a dealer of Silicon Solar:<br>
            	<textarea name="entry.757025132" id="entry_757025132" ></textarea>
            </td>
        </tr>
    </table>
    
    <p>Thank you for your application! Silicon Solar will deal with all applications on a first come, first served basis. You will be contacted shortly with information regarding your application. If deemed a potentially suitable candidate, a representative will contact you to discuss the next steps, and/or to potentially arrange a meeting and inspection of your operation.</p>
    <p style="font-weight:bold;">I certify that the information provided in this application is true and correct to the best of my knowledge and belief and understand and agree that I have a continuing obligation to advise Silicon Solar if there are any changes in circumstance.</p>
    
    <p style="text-align:center;"><input type="checkbox" name="entry.778650019" id="group_778650019_1" value="Agree">I Agree <em>(required)</em></p>
    
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